旋转点下移的外踝上穿支皮瓣在修复前足软组织缺损的临床应用

Clinical application of lateral supramalleolar perforator flap with the rotation point down on the repair of forefoot soft tissue defect

目的探讨应用旋转点下移的外踝上穿支皮瓣修复前足软组织缺损的临床效果。方法自2016年1月至2017年6月,应用旋转点下移的外踝上穿支皮瓣修复前足软组织缺损23例,其中男15例,女8例,年龄为8~67岁,平均42.9岁。损伤位置均位于足部跖跗关节以远,创面面积4.0 cm×4.0 cm^8.0 cm×12.0 cm,皮瓣供区直接拉拢缝合或于大腿取游离刃厚皮片进行修复。术后采用电话及网络、门诊和家访等方式定期随访。结果21例皮瓣顺利成活;1例皮瓣远端小面积坏死,经换药后愈合;1例皮瓣远端出现张力性水泡,拆除部分缝线后,皮瓣成活。本组术后获得6~12个月的随访,皮瓣外形不臃肿,质地良好,患肢行走无明显影响,功能恢复满意。结论旋转点下移的外踝上穿支皮瓣穿支恒定,切取简便,是修复前足软组织缺损的一种良好方法。

Objective To investigate the clinical effect of lateral supramalleolar perforator flap with the rotation point down on the repair of forefoot soft tissue defect. Methods From January, 2016 to June, 2017, 23 cases(15 males and 8 females) of forefoot soft tissue defect were repaired by lateral supramalleolar perforator flap with the rotation point down. The age ranged from 8 to 67 (mean, 42.9) years. The soft tissue defects were located far from the tarsometatarsal joint of the foot and the areas were 4.0 cm×4.0 cm-8.0 cm×12.0 cm. The areas of flap stitched directly or take blade thick skin repair on the thigh. All cases were followed-up by telephone or Internet, outpatient visit and home visit. Results Twenty-one cases survived successfully. Small area necrosis occurred at the distal end of the flap in 1 case, and healed after changing treatment. In the other cases, tension blister appeared at the distal end of the flap. After cut off some surgical stitches, the flap survived. All cases were followed-up from 6 to 12 months. The shape of flaps were not bloated and had good textures. The walking of affected limbs had no significant effect, and the functional recovery was satisfactory. Conclusion The lateral supramalleolar perforator flap is easy to cut and the perforator of flap is constant, which is a appropriate flap to repair the soft tissue defect of the forefoot.